Symptoms are a poor indicator of reflux status after fundoplication for gastroesophageal reflux disease: Role of esophageal functions tests

Carlos A Galvani, Piero M. Fisichella, Maria V. Gorodner, Silvana Perretta, Marco G. Patti, Carlos A. Pellegrini, Philip E. Donahue, Raymond J. Joehl, Stephen G. Jolley, John R. Edwards

Research output: Contribution to journalArticle

79 Citations (Scopus)

Abstract

Background: If a patient develops foregut symptoms after a fundoplication, it is assumed that the operation has failed, and acid-reducing medications are often prescribed. Esophageal function tests (manometry and pH monitoring) are seldom performed early in the management of these patients. Hypothesis: In patients who are symptomatic after fundoplication for gastroesophageal reflux disease, a symptom-based diagnosis is not accurate, and esophageal function tests should be performed routinely before starting acid-reducing medications. Design: Prospective study. Setting: University hospital. Patients and Methods: One hundred twenty-four patients who developed foregut symptoms after laparoscopic fundoplication (average, 17 months postoperatively) underwent esophageal manometry and pH monitoring. Sixty-two patients (50%) were taking acid-reducing medications. Main Outcome Measures: Postoperative symptoms, use of antireflux medications, grade of esophagitis, esophageal motility, and DeMeester scores. Results: Seventy-six (61%) of the 124 patients had normal esophageal acid exposure, while the acid exposure was abnormal in 48 patients (39%). Only 20 (32%) of the 62 patients who were taking acid-reducing medications had reflux postoperatively. Regurgitation was the only symptom that predicted abnormal reflux. Conclusions: These results show that (1) symptoms were due to reflux in 39% of patients only; (2) with the exception of regurgitation, symptoms were an unreliable index of the presence of reflux; and (3) 68% of patients who were taking acid-reducing medications postoperatively had a normal reflux status. Esophageal function tests should be performed early in the evaluation of patients after fundoplication to avoid improper and costly medical therapy.

Original languageEnglish (US)
Pages (from-to)514-519
Number of pages6
JournalArchives of Surgery
Volume138
Issue number5
DOIs
StatePublished - May 1 2003
Externally publishedYes

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Fundoplication
Gastroesophageal Reflux
Acids
Manometry
Esophageal pH Monitoring
Esophagitis

ASJC Scopus subject areas

  • Surgery

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Symptoms are a poor indicator of reflux status after fundoplication for gastroesophageal reflux disease : Role of esophageal functions tests. / Galvani, Carlos A; Fisichella, Piero M.; Gorodner, Maria V.; Perretta, Silvana; Patti, Marco G.; Pellegrini, Carlos A.; Donahue, Philip E.; Joehl, Raymond J.; Jolley, Stephen G.; Edwards, John R.

In: Archives of Surgery, Vol. 138, No. 5, 01.05.2003, p. 514-519.

Research output: Contribution to journalArticle

Galvani, CA, Fisichella, PM, Gorodner, MV, Perretta, S, Patti, MG, Pellegrini, CA, Donahue, PE, Joehl, RJ, Jolley, SG & Edwards, JR 2003, 'Symptoms are a poor indicator of reflux status after fundoplication for gastroesophageal reflux disease: Role of esophageal functions tests', Archives of Surgery, vol. 138, no. 5, pp. 514-519. https://doi.org/10.1001/archsurg.138.5.514
Galvani, Carlos A ; Fisichella, Piero M. ; Gorodner, Maria V. ; Perretta, Silvana ; Patti, Marco G. ; Pellegrini, Carlos A. ; Donahue, Philip E. ; Joehl, Raymond J. ; Jolley, Stephen G. ; Edwards, John R. / Symptoms are a poor indicator of reflux status after fundoplication for gastroesophageal reflux disease : Role of esophageal functions tests. In: Archives of Surgery. 2003 ; Vol. 138, No. 5. pp. 514-519.
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abstract = "Background: If a patient develops foregut symptoms after a fundoplication, it is assumed that the operation has failed, and acid-reducing medications are often prescribed. Esophageal function tests (manometry and pH monitoring) are seldom performed early in the management of these patients. Hypothesis: In patients who are symptomatic after fundoplication for gastroesophageal reflux disease, a symptom-based diagnosis is not accurate, and esophageal function tests should be performed routinely before starting acid-reducing medications. Design: Prospective study. Setting: University hospital. Patients and Methods: One hundred twenty-four patients who developed foregut symptoms after laparoscopic fundoplication (average, 17 months postoperatively) underwent esophageal manometry and pH monitoring. Sixty-two patients (50{\%}) were taking acid-reducing medications. Main Outcome Measures: Postoperative symptoms, use of antireflux medications, grade of esophagitis, esophageal motility, and DeMeester scores. Results: Seventy-six (61{\%}) of the 124 patients had normal esophageal acid exposure, while the acid exposure was abnormal in 48 patients (39{\%}). Only 20 (32{\%}) of the 62 patients who were taking acid-reducing medications had reflux postoperatively. Regurgitation was the only symptom that predicted abnormal reflux. Conclusions: These results show that (1) symptoms were due to reflux in 39{\%} of patients only; (2) with the exception of regurgitation, symptoms were an unreliable index of the presence of reflux; and (3) 68{\%} of patients who were taking acid-reducing medications postoperatively had a normal reflux status. Esophageal function tests should be performed early in the evaluation of patients after fundoplication to avoid improper and costly medical therapy.",
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AU - Perretta, Silvana

AU - Patti, Marco G.

AU - Pellegrini, Carlos A.

AU - Donahue, Philip E.

AU - Joehl, Raymond J.

AU - Jolley, Stephen G.

AU - Edwards, John R.

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